Long-term outcomes after laparoscopic total mesorectal excision for advanced rectal cancer.

PURPOSE The aim of this study was to evaluate the long-term outcomes of laparoscopic total mesorectal excision in the treatment of advanced rectal cancer in a randomised population. METHODS Between 2001 and 2005, 125 patients (70 males, 55 females, mean age 55.5 (standard deviation (SD) 11) years, range 25 - 81 years) with rectal cancer were evaluated and prospectively followed up in our hospital (mean follow-up 42 (SD 23 months, range 5 - 113 months). The 5-year overall survival rate, 5-year disease-free survival rate and recurrence rate were analysed. RESULTS There were 54 cases of cancer defined as UICC stage II and 68 cases defined as stage III. Of these cases, 22 were localised to the upper rectum, 50 to the middle rectum and 53 to the lower rectum. The 5-year overall survival rates were 71.3% and 51% among the stage II and the stage III patients, respectively. The 5-year disease-free survival rates were 59.2% and 45.4% among the stage II and the stage III cancer patients, respectively. The overall recurrence rate was 16.8% (local recurrence rate 11.25%, distant recurrence rate 8%). Multivariate analysis showed that age and size were independent predictors of overall survival (p=0.006 and p<0.001 for stage II and stage III patients, respectively). CONCLUSIONS Our results suggest good long-term outcomes of laparoscopic surgery in the treatment of rectal cancer. However, this technique should be used with caution in older patients and patients with larger tumours.